9901-081 (SFD)LICENSED CONTRACTOR DECLARATION
I hereby affirm under penalty of perjury that I am licensed under provisions of
Chapter 9 (commencing with Section 7000),of.Division 3 of the Business and,
Professionals Code, and my License is in full for and effect.
License # Lic. Class Exp. Date
43n ��
ate 1 � 1 JM� Signature of Contractor
OWNER -BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from the Contractor's
License Law for the following reason:
( ) I, as owner of the property, or my employees with wages as their sole
compensation, will do the work, and the structure is not intended or offered for
sale (Sec. 7044, Business & Professionals Code).
( ) I, as owner of the property, am exclusively contracting with licensed
contractors to construct•the project (Sec. 7044, .Business & Professionals
Code). .
O I am exempt under Section B&P.C: for this reason
Date Signature of Owner
WORKER'S COMPENSATION DECLARATION
I hereby affirm, under -penalty oP perjury one„of the following declarations:
() I have and will maintain a certificate of consent to self -insure for workers'
compensation, as provided for by Section 3700 of the Labor Code, for the
performance of the work;for which this permit is issued.
( I have and will maintain workers' compensation insurance, as required by
Section 3700 of the Labor Code, for the performance of the work for which this
permit is issued. My workers' compensation insurance carrier & policy no. are:
Carrier Policy No.
vT TY9-PT\1^1 �t tP.'i/'v 1a•,1 },v%I ,%Na}} ROP�� M
at! s 4U., r.nCsa' IC 1N,,1 1ti Y►d9dV � / UJ4 V!)
(This section need not be completed if the permit valuation is for $100.00 or less):
( ) I certify that in the performance of the work for which this permit is issued,
I shall not employ any person in any manner so as to become subject to the
workers' compensation laws of alifornia, and a ree�that if I should become
subjecYio he orkers' compenea ion provis�ns( If Section 3700 of the,Labor
Cggde I I ew th comply wit hose `pro isio s.,, jt
Plate: Applicant _ 6L,
Warning: Failure to secure Workers' Compensation coverage is unlawful and
shall subject an employer to criminal penalties and civil fines up to $100,000, in
addition to the cost of compensation, damages as provided for in Section 3706
of the Labor Code, interest and attorney's fees..
IMPORTANT Application is hereby made to the Director of Building and Safety
for a permit subject to the • conditions and restrictions set forth on his
application.
1. Each person upon whose behalf this application is made & each person at
whose request and for whose benefit work is performed under or pursuant to
any permit issued as a result of this applicaton agrees to, & shall, indemnify
& hold harmless the City of La Quinta, its officers, agents and employees.
2. Any permit issued as a result of this application becomes null and void -if
work is not commenced within 180 days from date of issuance of such
permit, or cessation of work for 180 days will subject permit to cancellation.
I certify that I have read this application and state that the above information is
correct. I agree to comply with all City, d State laws relating to the building
construction, and hereby authorize r pfe�en atives of this City to enter upon
the above-mentioned prope I f°r insect on q1poses.
I/10 'Signature (Owner/Agent)`Date 1 `7�.
. f 1'
PERMIT #
BUILDING PERMIT 1
`LOT
DATE VALUATION TRACT
52oti1.696.lta L4 zt�. trla,e
I -
JOB SITE r
ADDRESS''�y
APN
OWNER
CONTRACTOR/DESIGNER/ENGINEER
4 ' Ir f ' 6” 171
4 ,Y t'i:,A"1:1.4..1 2.. I Y.l 1
• 1. i•. /y .:. N, L'�A./A�.Lr1. 4 �!� -
716.1 lTNiWikNA..AVE.
7161 INDT A.► A 1'1._WE
1t,IV:(f RS11:30: CA 92M4
RIVERS1� E11 CA. 91,504
C Rdf 53511
USE OF PERMIT
LOT �f, 7P.%A h1 - e� P:AM1'T u 063 r (YUgCLU1)'8 BLOCK WALL 0R
A-�IWL. PLAN 1:1iF:f;3o FEE f3,EDUC.I,C) 775' •e 1'0R MULT'. PIX I ai` UA.11 CE OV
SAME _PLAN' TYPE
1
USIN YLVI C'OMST2LC r1O.t1 6,379,40 a7�{'
'
C3R%_AC1 CF�1 '0+4� 631,(NJ is
ENTlfp!['iFi EDY vr,ftg3d V�9.p '6,se�vi1 J.8 9.!'4rR .iM.Yt�.�
&Yri11v) EPs 1. 101
.P RM.n: FEE S$JWMA Y
C0KS'TPVC T101J . ;tea 101-000-418-400 3993.01)
t, te7 +M'taVr",)v 10;3 -00 --4 -3113 � � .c�►
tFXNANICAIL Fra -1 10.1-000-421-000 $9d.Q0
LCC i`i2dCA;LrM� 101-000-420-000
1,LUB(NG F'iffiz L01-OOt)�413-001` $it�x ?
s'ma—arc;,!vic?noNi'rm..:rwo) ?OJ- 00-ui—000 $20,07
GRADINGi 'PRE 101-000A23-000 $20,00
1NfrAMT[1isCIUMl, PM 223-000-443.342 U,449,83
!!_RT fN PUBLIC PLAM - RRISW `%01-M-235.000 $^2.5:1.14
SUPA-TUM CONS?- UC,'nO',N'.A?D PL -AIN 4:'M-rrC.,
$6. 45 A,f
.MOO
LESS P' I E, -PAID FEF.,
WfAl" i€`$?rlFd•t'V1IT V, Flits DUE, N W
$6,345.61
RECEIPT
`
DATE S
BY / �f;N�
(DATE FINALED
INSPECTOR
j
�r INSPECTION RECORD
OPERATION
DATE
INSPECTOR
OPERATION
DATE
INSPECTOR
BUILDING APPROVALS
MECHANICAL APPROVALS
Set Backs
Underground Ducts
Forms & Footings
Ducts
Slab Grade
Return Air
Steel
Combustion Air
Roof Deck
Exhaust Fans
O.K. to Wrap
F.A.U.
Framing /
Compressor
Insulation S
Vents
Fireplace .L.
Grills
Fireplace T.O.
Fans & Controls
Party Wall Insulation
Condensate Lines
Party Wall Firewall
Exterior Lath S
Drywall - Int. Lath
Final
Final
BLOCKWALL APPROV L
POOLS - SPAS
Steel
Set Backs
Electric Bond
Footings
Main Drain
Bond Beam
Approval to Cover
Equipment Location
Underground Electric
Underground Plbg. Test
Final
Gas Piping
PLUMBING APPROVALS
Gas Test
Electric Final
Waste Lines
Heater Final
Water Piping
Plumbing Final
Plumbing Top Out
Equipment Enclosure
Shower Pans
O.K for Finish Plaster
Sewer Lateral 01
Pool Cover
Sewer Connection
Encapsulation
Gas Piping
Gas Test
Appliances
Final
Final
Utility Notice (Gas)
ELECTRICAL APPROVALS
Temp. Power Pole
Underground Conduit
Rough Wiring
Low Voltage Wiring
Fixtures
Main Service
Sub Panels
Exterior Receptacles
G.F.I.
Smoke Detectors
Temp. Use of Power
Final /
Utility Notice (Perm)
COMMENTS:
$�. OWEN$-CORNING a�
t Fiberglas.
fl -Building _'Insulation
r,
14:'
° -The contractor'named below certifies that the Owens-Corning Fiberglas Building
=' Insulation used carries the NAHB Research Foundation, Inc. label for assured
` thermal performance and that the Building Insulation is installed in comformance
with the current energy conservation regulations, California Administrative Code,
`Title 24;.State of California, in the building located at:
80-030 MELON LA QUINTA 2834x3 LOT 4
Address City Tract Number
Eztenor Walls.
;.Owens-Coming Fiberglas Type B7 Insulation'
--.....�... BLOW
Owens -Coming Fiberglas Type Insulation.
Owens=Corning Fiberglas Type_
f
:. �- foundation Walls
Manufacturer
-
.;"(31,66ral Contractor
3112
R -15U
Thickness
R -Value
16114
R-38
Thickness
R -Value
Insulation
Thickness R -Value
Type Thickness R -Value
License No.
By. Title Date
4r insulation Contractor
- t� Paragon Insulation License No. 63207
T By —� ivev SIL.- Title..r., Date 01010
5Eu _9
yPub. No. 15 -BL -14725
uho in U.S.A Sept. 1987, Copyright ® 1987 Owens -Coming Fiberglas Corp.
OWENS-CORNING FIBERGLAS CORP.
Insulation Operating Division
Fiberglas Tower, Toledo, Ohio 43659
.. AV \ -
. i
_uer
iricate.0f uccupancy
COFUY. ��l
Building and Safety Department FM of
This Certificate issued, pursuant to -the. requirements of Section 109 .of the Uniform Building Code,
certifying that, at the time of -issuance,. this structure was in compliance with the various ordinances
of the City regulating building, construction or use. For the following-
BUILDING
ollowing:BUILDING ADDRESS: 80-030 MERION
Use Classification: SINGLE FAMILY DWELLING Bldg. Permit No.: 9901-081
Occupancy Group: R-3 ,Type'of 'Construction: VN Land Use Zone: RL
1
Owner of Building: STEVEN WALKER HOMES Address: 7161 INDIANA AVE.
City: RIVERSIDE, CA., 925004
By: DANIEL. P. CRAWFORD JR.
Date: 9/29/99
Building Official;, `.
POST IN A CONSPICUOUS PLACE
A44